Is there a connection between sugar and migraines, or as we like to call them, migraine attacks?  Could sugar be a hidden cause or trigger behind many migraine attacks today?

We should start by admitting that there is a difference of opinion about just how much sugar consumption impacts migraine symptoms.

 Some say that it’s a major cause or trigger, but most would admit that there is a connection between blood sugar levels and at least some migraine attacks.

To understand the connection, we need to clear up some misunderstandings about sugar.  There are all kinds of terms floating around, like "unrefined sugar" (wow, that sounds natural!), or course there’s "natural sugars" (as opposed to supernatural sugars, I suppose) and "sugar from natural sources".

What sugar does…

When we talk about blood sugar, what we’re referring to is glucose.  All these different types of sugars (and we could talk about all the different kinds in foods) impact glucose levels in the blood, though to different extents.

So if you want to make it real simple, you can simply say that carbohydrates such as sugar will raise your blood sugar levels.

But here’s the rub – they change glucose levels to different degrees, and on different time tables.

For example, if you eat a raw carrot, it’s sweet (if it’s a good one).  It will raise your blood sugar levels.

If you eat a white bagel, it might not taste as sweet, but it will raise your blood sugar levels too.

However, there’s a difference.

 You could say it this way, to use a very rough analogy.  The sugars in the carrot are carefully packaged up, using a lot of scotch tape and wrapping paper.  The sugars in the bagel are hardly packaged up at all – in fact, you just pop open the lid and there you are.

So the when you eat the bagel, the package is very quickly opened and your blood sugar levels rise very quickly.

When you eat the carrot, your body unwraps the sugars slowly, and so your blood sugar levels don’t spike the same way – the glucose is gradually added to your blood stream over time.

Now there are other differences with different types of sugar, which can make the situation much more complex.

So could sugar cause migraines?

But we do know that the migraine brain does seem to have a special alarm that goes off when there are sudden changes.  This could do with hormones in your body, with temperature, with sudden exercise, environmental changes, any number of things.

So these things do not cause migraine, but they can trigger migraine attacks.

What is the relationship between sugar and migraines?

Let’s be clear.  This does not mean that eating too much sugar will cause migraine.  In other words, neither is sugar a direct cause, nor could anyone get migraine disease by eating too much sugar.

But if you’re a migrianeur, predisposed to migraine attacks, eating a lot of sugar – and here we’re talking about "poorly packages" sugars – could lead to more attacks, more symptoms.

How?

It could simply by that alarm that goes off when there are sudden changes in the body.  But for some people, it could be something more.

For example, some have noticed a "cumulative effect" – eating sugars over two or three days, for example, may trigger an attack.

Others have found that if they completely cut out refined sugars, they lessened or eliminated their migraine attacks after a time.

There could be some complex reasons for this relationship.  We do know that glucose, insulin, and nitric oxide are closely related.  We’ve talked about glucose, and if you know anyone with diabetes you know a little about insulin.  But people with diabetes are also likely to have impaired nitric oxide pathways.  Problems with these pathways could lead to problems with insulin, and with blood sugar levels.

A study in 2009 suggested that migraineurs are also more likely (than the general population) to have impaired nitric oxide pathways.

This could be at least one other clue into why migraineurs may be more sensitive to refined sugars (and refined flours and any poorly packaged carbohydrates) than most people.

Migraineurs should be cautious about blood sugar level spikes.  One way people often address this is by using the Glycemic Index.  Others have completely cut sugar out of their diets for several months.

What have you tried?  Any success stories?

From the Headache and Migraine News Blog

Sugar and Migraines?

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Confused about the difference between chronic daily headache and chronic tension type headache?  Let’s talk about it.

This month a report came out about the use of Botox for various headache disorders.  The meta-analysis (a study of earlier studies) concluded that Botox had been helpful for "chronic daily headache" and "chronic migraines", but had not yet been proven useful for "episodic migraine" or "chronic tension-type headache".

Now of course this doesn’t prove too much – just that the studies so far seem to show that Botox is more useful for people with some diagnoses and not for people with other diagnoses.  It could mean some have been studied more than others, or that we have not yet found the right type of Botox treatment, or it could mean that Botox simply isn’t useful in some conditions.  We don’t really know.

But what stood out to me was the use of the term chronic daily headache.  What does that term actually mean?  And why is it different from chronic migraine or chronic tension-type headache?

Having not read the full study, I’m not sure how the authors are using the term, but I suspect from the abstract that they’re taking it from the studies they’re using.  Which makes things even more tricky.

Chronic Daily Headache (CDH) is not really a specific term for a headache disorder, but a general term.  This means that chronic migraine and chronic tension-type headache could both be called chronic daily headache.

CDH could be:

• chronic cluster headache
• chronic migraine
• chronic paroxysmal hemicrania
• chronic tension type headache
• hemicrania continua
• new daily-persistent headache
• short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing

With all of these disorders, attacks come either constantly or at least 15 days a month.  CDH are a huge problem.  It has been estimated that up to 5% of the population have significant CDH symptoms.  Most have chronic migraine.

Often CDH is related to the overuse of medication (such as triptans or acetaminophen / paracetamol, in which case you may be diagnosed with one of the above and medication-overuse headache, or it could be diagnosed as one or the other.

Because of the confusion over the terminology, or simply ignorance about the classifications, many patients are diagnosed with chronic tension type headache when they really have a different type of CDH.

Chronic Tension-Type Headache starts with episodic tension-type headache.  In other words, first the patient has the occasional TTH, and later ends up with chronic TTH.  Usually there’s pain on both sides of the head, feeling like a pressing or tightening.  Physical activity probably won’t make it worse, but there is sometimes some mild sensitivity to light or noise, and possibly a little nausea (but not vomiting) – one, but not all three.

Chronic migraine, in contrast, usually starts with migraine attacks which eventually become chronic.  The symptoms are migraine-like.

Now with both chronic migraine and chronic tension-type headache, your doctor will want to rule out other conditions.  It is possible to have the symptoms of chronic TTH, and yet actually have a different diagnosis.

If you have been diagnosed with CDH, try to get a more specific diagnosis.  Why?  Because as research continues, there are treatments that will be more likely to help you depending on which type of chronic condition you have.  The more you can narrow it down, the quicker you can get treatment that works.

For more of a breakdown of CDH types, see the National Headache Foundation’s topic sheet on Chronic Daily Headache.

From the Headache and Migraine News Blog

Chronic Daily Headache vs. Chronic Tension-Type Headache

These other posts might relate:

• Botox and Quality of Life: Does it really help?
• Breaking News: Botox approval from FDA
• What is Transformed Migraine?

This is an interview (audio only) from the National Headache Foundation featuring Dr. Robert Shulman.  In the interview, Dr. Shulman gives an overview and also answers common questions.

From the Headache and Migraine News Blog

Migraine and Depression with Dr. Robert Shulman (audio)

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I often encourage people to think about putting together a "team" of medical professionals as they seek proper treatment.  This could mean simply working with a number of different doctors, complimentary health care providers, a dentist, etc – and making sure they all have the right information and are working toward the same goal.

(My thinking on this was really challenged by the useful book What’s Wrong With Me by Lynn M. Dannheisser and Dr. Jerry M. Rosenbaum, an excellent book now available in Kindle format).

Another way to find a team (or a part of your team) is to find one that already exists – in what we might call a multidisciplinary pain clinic.

Today I would like to ask Dr. Michael Zitney to share his thoughts on these types of clinics from the inside.  Dr. Zitney is the director of the Headache & Pain Relief Centre in Toronto, Canada.  Let’s here what he has to say:

Many doctors can treat pain; an orthopaedic surgeon treats broken bones, neurologists treat migraines, anaesthesiologists block painful nerves, cardiologists treat chest pain caused by angina and family doctors treat all sources of pain every day.  However, when an ongoing painful condition negatively impacts the way you function on a daily basis, there are tremendous advantages to attending a Multidisciplinary Chronic Pain clinic.

If you are having success at your currant clinic, continue with treatment.  If you are not making progress after a reasonable effort, ask for a referral to a Multidisciplinary pain clinic.

From the Headache and Migraine News Blog

Should I try a Multidisciplinary Pain clinic? (Guest Post)

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• 1% Thursday: Develop Your Team
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There is increasing evidence that those who a diagnosis of sinus headache, or a self-diagnosis of sinus headache, should NOT be taking antibiotics.  Why?

First of all, a number of studies have suggested that many – perhaps most – perhaps even 80%-90% – of these patients actually have migraine.

So chances are you should be taking migraine meds instead of sinus meds.

A study published in Neurology in 2002 (Lipton et al) looked at patients with migraine who also supposedly had sinus headaches.  Patients were given analgesics, antihistamines, and/or decongestants for their headaches.  About half were dissatisfied with these treatments.

These patients then took migraine medication for two of their "sinus headaches" – in this case, sumatriptan.  Surprise surprise, 73% had pain relief within 2 hours.  45% were pain free within two hours!

Antihistamines, decongestants, antibiotics – all big business.  But what if most were being given to the wrong people?

The misdiagnosis likely has to do with the high prevalence of congestion and other sinus headache symptoms in migraine.  Many people don’t realize that congestion is common in a migraine attack, or even nasal discharge.  And many doctors are confused as well.

But what if you’ve had a proper work-up, and you believe you do have a sinus infection?  (More on how to differentiate between a migraine attack and sinus headache here)  Chances are you should still say NO to antibiotics.

Most often, sinus headaches from an infection are due to a virus infection – and a virus infection will not be helped by antibiotics.

A recent study in the Journal of the American Medical Association confirms this in real life.  85 adults with uncomplicated acute sinusitis were given an antibiotic, and 81 were given a placebo.  (see Author Insights: Treatment of Acute Sinusitis With Antibiotics Often Futile)

At 3 days, there was no difference between the groups in quality of life or symptom relief.  At 10 days, there was no difference between the groups in quality of life or symptom relief.  No difference!

In the USA, 1 in 5 antibiotic treatments is given to someone with sinusitis.  That’s a HUGE number of people in one country alone getting a medication they don’t need, that won’t help them!

And those were patients who most likely really had sinusitis.

Now take the few that remain – should we give them antibiotics?  Most likely not.

That’s millions of people with so-called sinus headache – almost all of whom should should NOT be taking antibiotics (or antihistamines, or decongestants…).  And that probably means you, sinus headache sufferer.

In a world where we’re more and more concerned about the personal and worldwide impact of overuse of antibiotics, it’s time we cut those millions of prescriptions.  If you’re not sure, do some research and be sure that you not only have a sinus infection, but an actual bacterial infection (not viral), AND that it’s worth it to take the antibiotics.

Unless you’re in that tiny minority, do yourself and us a favour – get a proper diagnosis, and if you need to take something that will actually help you.

From the Headache and Migraine News Blog

Sinus Headache: Say NO to Antibiotics!

These other posts might relate:

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• A Very Special “Skin Patch” for Migraine

Botox, or onabotulinumtoxinA, is an emerging and at times controversial treatment for migraine.  Many patients have found relief through Botox treatment, although others have found that it wasn’t very helpful for them.  Par for the course when it comes to migraine treatment.

But just why does Botox help – at least some patients?

The most obvious answer seems to be the way it relaxes muscles.  Certainly if tense muscles were triggering migraine attacks, or if they were a part of the chain-reaction or vicious-cycle of migraine, we would expect to see some relief if those muscles were relaxed.

And that still could be part of the answer.

But the pain of migraine (in fact, even the pain of tension-type headaches), does not come from muscle tension.  Sure, it could be a part of the cycle, but is that really enough to explain the relief that many get from Botox?

Dr. Alexander Mauskop from the New York Headache Clinic writes about his observations:

I have seen some patients who would report that injecting muscles around the head eliminated pain in the injected areas, but that they still had pain on the top of the head.  There are no muscles on the top of the head and we usually do not inject Botox there, but in those patients who do have residual pain on the top, injecting Botox stops the pain.  Recent research has shown that Botox in fact also exerts a direct analgesic (pain-relieving) effect.  This is supported by my and other doctors’ observation that Botox also helps other types of pain, such as that of shingles or trigeminal neuralgia.

He goes on to point out that we need some solid studies to confirm what many doctors and patients are seeing.

He finishes by saying that Botox seems to help by reducing the pain messages that are being sent to the brain.  Without the flurry of pain messages to the brain, the migraine chain reaction can’t begin.  In fact, some patients report that, after Botox treatment, they sometimes feel like a migraine is about to start, but it never does.

If you’ve had Botox treatment, how does this compare with your experience?  Leave a comment!

From the Headache and Migraine News Blog

Botox for Migraine – how does it actually work?

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I was recently sent this infographic from The Mount Sinai Hospital in New York.

Infographics can be useful summaries.  But sometimes when we summarize information, we can miss important things.  How do you think this infographic does?

Source: Mount Sinai Medical Center

From the Headache and Migraine News Blog

Headache Infographic – What do you think?

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Clinical trials are tricky – one can say one thing, one can say another.  But what if people with a financial interest could hide the ones you didn’t like, and only use the ones you did like?

A series of studies in the British Medical Journal suggest that clinical trials are missing – trials that may say something quite different than what the public is hearing.

In the United States, the government is trying to tighten up on requirements for clinical trials.  One of these regulations is that all eligible clinical trials must be reported (on ClinicalTrials.gov) within one year of the study’s conclusion.  This came into effect in 2007.

This database has an impressive list of studies – currently 119,213 trials from 178 countries.  So whether or not trials are reported truly has a global impact.

So has the new requirement solved the problem?  Not a chance.  One study found that only 22% of the eligible trials had been reported after 12 months!  (see Compliance with mandatory reporting of clinical trial results on ClinicalTrials.gov)  Another study found that 50% of trials funded by the National Institutes of Health were published after 30 months, and a third of them were still unpublished after 51 months.  (see Publication of NIH funded trials registered in ClinicalTrials.gov)  Yes, that’s over 4 years!

Another study found that even when studies were reported on Medline (an online database of trials), they weren’t properly tagged and indexed.  (see Understanding why evidence from randomised clinical trials may not be retrieved from Medline)

–>>> This means basically that someone could do a well-designed clinical trial related to cluster headache or migraine, then not report the results for a few years.  Even when they do report it, they can leave off tags so that no one can find it.  Even if they do find it, many will miss studies that are so old.

Why is this happening?  Don’t scientists want to publish their work?

Admittedly, some of this could come from a misunderstanding of the rules, laziness, simple mistakes, and so forth.  There’s also time and expense to consider – it may be easier for a large company to publish than a smaller one with limited resources.

But the reality is that many of these studies are sponsored by the companies that sell you the medication you use.  If a study says something the drug company doesn’t like – the study may just disappear.  And that’s a scary thought.

Often researchers will publish a meta-analysis of the available studies.  For example they could take the data from 12 trials of a certain drug, and tell us that, according to 8 of the studies, the drug is very effective.  That sounds good until you realize there could be 12 more trials out there somewhere that say the opposite.  One study found just that – the missing data often contradicted what the meta-analysis studies were telling us.  (see Effect of reporting bias on meta-analyses of drug trials: reanalysis of meta-analyses)

The answer isn’t easy.  Clinical trials can be tricky to regulate.  And it’s even harder if you’re a small fish playing in the same pond with the huge drug companies.

But if the rules are there, they need to be enforced.  And the public needs to know when they’re not being enforced.

The world of clinical trials is not as pure, easy to understand, and efficient as many people believe.  It’s more important than ever for the buyer to beware – do your own research, be cautious, and don’t believe everything you read – even if it’s in a medical journal.  What’s missing may change a whole lot.

From the Headache and Migraine News Blog

The Case of the Missing Studies: Patients missing critical information

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There may be few surprises in the overall message of this video (although some of the details are quite interesting), but we all need motivation… and what a great way to start a Monday!

The author is Dr. Mike Evans.  Dr. Evans is founder of the Health Design Lab at the Li Ka Shing Knowledge Institute, an Associate Professor of Family Medicine and Public Health at the University of Toronto, and a staff physician at St. Michael’s Hospital.  Check it out…

From the Headache and Migraine News Blog

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This past summer at the annual conference of the American Headache Society, researchers and specialists discussed a something that we’ve known about for a long time – but still don’t take full advantage of.  That is, the premonitory phase of a migraine attack (formerly called prodrome).

Some people call it the first part of a migraine attack – others talk about it as a "warning phase".  But whatever you call it, it’s a time when there are symptoms before the full-blown symptoms at the height of an attack.

Researchers are especially interested in the premonitory phase because of the possibility of treating migraine before it gets out-of-hand.

What are some of these early-warning symptoms?  Dr. R. Allan Purdy suggests that mood changes are common – sadness or euphoria, for example.  Also, yawning, increased sensitivity to light and sound, trouble with concentration, paleness, and fatigue.  Sometime patients just "know" that a migraine attack is coming.

Dr. Purdy says,"Migraine is for many people a lightning storm that starts hours or day similar to gathering clouds before the storm, followed by the thunderous pain of the migraine headache.  The premonitory phase is well-documented but only recently have scientists considered if migraine can be treated before a patient is in full attack mode."

Some believe that, for example, taking triptans early in an attack can greatly increase your chances of successfully treating the symptoms.

What does Dr. Purdy advise?  "Until we fully understand the neurobiology of this phenomenon, our advice to patients is to stay alert to the presence of these symptoms and slow down to allow the body to adjust to what maybe coming if a migraine occurs."

Be aware, slow down, and try treating the migraine early.  Have you found that doing these things makes a difference in your symptoms?

via: Many migraine sufferers can predict their migraine attack — may create new treatment possibilities

More about premonitory symptoms and treating migraine

From the Headache and Migraine News Blog

The Gathering Storm: Predicting Migraine Attacks

These other posts might relate:

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